Certified Registered Nurse Anesthetist (CRNA) vs. Physician Assistant (PA): Which Career Path is Better?


Written By: Caitlin Goodwin MSN, CNM, RN

Saving lives is the best possible job in the world. But it can be difficult to choose which career will best fit your strengths. The public calls medical professionals as a nurse or a doctor, but there are so many professions in between. You may feel frozen while choosing between becoming a CRNA vs PA. A CRNA is an Advanced Practice Nurse who specializes in anesthesia. A Physician Assistant is a medical professional that diagnoses illness, creates treatment plans, prescribes medications, and can serve as the primary care provider (PCP).

Which degree is better for you? This article will compare the critical information that you need to know to become a Certified Registered Nurse Anesthetist or a Physician Assistant, including what to expect each day at work, the salary, and the job outlook.


CRNA vs PA: What You Need to Know


A physician assistant (PA) offers many of the same health services as physicians. They work as part of a healthcare team across every medical specialty or setting. A PA works under the supervision of a physician.

PAs practice in every state, medical setting, and specialty. Their presence improves healthcare access and quality. PAs can diagnose, order medications and tests, and manage care as a primary care provider (PCP). PAs are versatile, which in turn improves community healthcare access and quality.

There are currently about 118,000 PAs in the United States. Physician assistants work across every medical setting and specialty.

• Medical offices
• Hospitals
• Operating rooms
• Urgent care centers
• Emergency Departments

A certified registered nurse anesthetist (CRNA) is an advanced practice registered nurse who is certified in anesthesia. Anesthesia simply describes the state of a medically managed, loss of sensation.

While CRNAs work closely with anesthesiologists, the specialists differ in that anesthesiologists are medical doctors. According to the American Association of Nurse Anesthetists (AANA), nurses were the first in the medical field to give anesthesia in the battlefields during the Civil War.

There are currently about 45,000 CRNAs in the country. CRNAs may specialize in obstetrics, cardiovascular, plastic surgery, dental, neurosurgery, critical, or respiratory care

CRNAs work in both inpatient and outpatient settings:

Inpatient

• Hospital operating rooms
• Obstetric units
• Pediatrics surgery

Outpatient

• Surgery centers
• Plastic surgery centers
• Dental offices
• Pain management centers


CRNA vs PA: Job Duties


Physician assistants and CRNAs perform some of the same duties in practice. Both professionals can:

• Take a patient’s history
• Conduct a physical assessment
• Educate patients
• Obtain informed consent
• Order and interpret tests
• Prescribe medication
• Develop treatment plans

Additionally, PAs also:

• Diagnose and treat illness
• Practice preventative care
• Assist in surgery
• Make rounds in hospitals and nursing homes
• Do clinical research
• Work as a primary care provider

CRNAs deliver anesthesia to critical patients using their training, experience, and skills. Certified registered nurse anesthetists collaborate closely with anesthesiologists.

CRNA job duties include:

• Administer anesthesia
• Manage a patient’s airway
• Make rounds in hospitals following anesthesia
• Monitor patients for oxygenation, ventilation, respirations, fluid balance, temperature, and neuromuscular status.
• Identify abnormal responses and respond with adjunctive medications and fluids to maintain homeostasis.
• Initiate an intravenous line.
• Epidurals
• Insert a peripheral or central line.
• Stabilize and recover patients.


CRNA vs PA: Skills Needed


The top three skills for a physician assistant include:

• Observant
• Steady under pressure- calm, emotionally stable
• Communication

As a CRNA, you should have the following skills:

• Team Player
• Compassion
• Flexible


Certified Registered Nurse Anesthetist vs Physician Assistant: Education Requirements


The educational process usually requires a graduate degree from an accredited program for both careers. After obtaining a Baccalaureate degree and completing the prerequisite classes, many applicants to both the PA and CRNA program already have some work experience.

The PA program includes classroom, laboratory, and clinical instruction. You will learn about anatomy, pathology, physiology, medicine, pharmacology, diagnosis, and ethics. Clinicals occur in specialties like family medicine, emergency medicine, women’s health, and pediatrics. Clinical rotations may even lead to permanent employment if the physician is impressed with your ability.

The CRNA program is complicated to prepare you for such an intensive career. You will take advanced physical assessment, pharmacology, advanced anatomy and physiology, cardiac and neurological anesthesia, and post-operative care.

According to AANA, CRNA students take a minimum of 2000 clinical hours and administer an average of 850 anesthetics before graduation. The rigorous CRNA program will prepare you to take the accreditation exam.


Program Length


If you have a bachelor’s degree, PA programs take at least 2 years of full-time study. However, PA programs typically take 27 months (nearly three academic years).

The program length for becoming a CRNA depends on whether you are already a Registered Nurse (RN). In order to become a CRNA, you need to have an active, unencumbered RN license and pursue your Master of Science in Nursing. It typically takes about 2 to 3 years, as well. However, if you are not a registered nurse, it will take at least another two more years.


PA vs CRNA: Program Cost


The annual tuition of health programs varies tremendously. The cost of a CRNA and PA program depends on whether you attend a public or private school, and if you are from the state or paying out-of-state tuition.

The CRNA program cost ranges from $25K to 110K for the entire program. For a public university, the range averages $6K to $18K each semester. Private schools are much more expensive at more than $30K per semester. The most costly programs can cost as much as $110K.

PA programs range from $32K to 110K for the entire program. For a public university, the range averages $10K to $20K each semester. Private schools are pricier. The most expensive programs can cost as much as $110K.

The cost is very similar to go from your Baccalaureate of Science in Nursing (BSN) to an MSN with a specialty in CRNA as it is to obtain your graduate degree for a PA. However, if you do not yet have your BSN, the road to a PA is much less expensive.


Admission Requirements


To be admitted into a PA program, you need a bachelor’s degree in any field with a minimum grade point average (GPA) of 3.0. You will also need to take the Graduate Record Examination (GRE) within five years of applying. Some schools will accept the Medical College Admission Test (MCAT). Most schools want you to have some kind of clinical experience.

You may need the following classes on your transcripts:

• Statistics
• Chemistry
• Biology
• Physics

To be admitted into a CRNA program, you need to have a bachelor’s degree and be a registered nurse with an active and unencumbered license. Nurses should have critical care work experience for at least two years, such as the Intensive Care Unit (ICU) and Critical Care Unit (CCU).

The prerequisites may vary by university. Most programs require a 3.0 GPA in the following coursework:

• Biology
• Chemistry
• Anatomy and Physiology (I and II)
• Microbiology
• Psychology
• Statistics
• Human Nutrition


CRNA vs PA: A Day in the Life


Both CRNAs and physician assistants’ day varies depending on their primary setting. Walking through a day with each professional will best display the differences between a CRNA and PA.

When living a day in the life of a PA who works in the ICU, you will quickly learn that you are a critical part of the team.

7:00 The PA meets with the ICU team and receives a report on all the patients in the unit.
7:30 Pre-round on four patients. Review all of their labs and vital signs.
9:00 Present the patients for rounds with the ICU team (physician and nurses).
11:00 Perform consults by triaging the most important first. After you perform consults, discuss with ICU team
2:00 There is a new admission to the ICU. As a PA you will place immediate orders and round on the patient.
3:30 Discuss patient with physician and nurses
4:00 Catch up with any charting and caffeinate.
5:00 The ICU team will start to pre-round for shift change at 7 PM.

*Rapid responses are randomly interspersed throughout the shift. Rapid responses are patients whose statuses are rapidly declining. The team consists of an ICU nurse, a respiratory therapist, and a PA.

The best part about being a CRNA is taking away your client’s pain. No day looks the same.

7:00 The CRNA’s day begins. After putting on hospital scrubs, a scrub cap, a surgical mask, and booties, it’s time to check the anesthesia equipment in the operating room (OR).

7:30 It’s time to get ready for the 8 AM case. The CRNA reviews the patient’s chart for any relevant medical history like cardiac issues or BMI. The CRNA will ask questions about their history as related to the surgery, perform a physical exam, and obtain informed consent. They will perform an American Society of Anesthesiology (ASA) score on a scale from one to five that is announced during a surgical time out.

8:00 Administer anesthesia for the surgery. Continue to monitor throughout the procedure for changes in vital signs, blood in the urine, or any sign of hemodynamic instability.

The rest of the day varies based on the length of the surgery and the health of the patient. Some surgeries may take the entire shift until the CRNA goes home at 7 PM. Other surgeries may be over in less than two hours, so the CRNA may see five in a day. Having patients’ lives in your hand is always a tremendous responsibility. After the surgery is over, the CRNA makes sure they are stable and transfers them to the PACU. CRNAs may also round on post-op patients following the conclusion of the procedure.


CRNA vs PA: Salary & Job Outlook


With an increase in demand for healthcare services due to an aging population, both careers have a positive job outlook. The Bureau of Labor Statistics describes the job outlook for a Physician Assistant as better than average. The employment of PAs is projected to increase by 31 percent between 2018 and 2028.

Physician assistants continue to have a growing role in medicine because they can be trained quickly, are increasingly covered by health insurance, and are a critical part of a collaborative team. PAs are especially needed in primary care for rural and underserved areas.

The job outlook for nurse anesthetists is not as impressive. In the next ten years, the need for CRNAs is projected to grow by 17%.

Since both jobs require significant responsibility and liability, let’s take a look at CRNA salary vs PA salary. According to Payscale, the average annual pay for a PA is $96,561. The salary range is between $78K to $124K. A CRNA makes significantly more money with an annual rate of $152,222 and the salary range is $101K to $199K


Certified Registered Nurse Anesthetist vs Physician Assistant: Which Career Path is Right for Me?


When choosing whether you should pursue a career in anesthesiology or as a PA, there is a lot to mull over. However, if you feel drawn towards pharmacology and using critical thinking to notice subtle changes in a patient’s status - a CRNA may be the way to go. If you’re looking to work in surgery or a medical office, consider PA. And when all else fails, ask to shadow your local professional for a day. You may be surprised by what you learn!


Conclusion


The above information should help you understand the difference between a CRNA and PA. Whether you choose to become either a CRNA or PA, you will make a difference in your patients’ lives. Both roles provide an essential role in the healthcare system. If you’re still undecided, read our article about the difference between nurse practitioners and PAs.


Caitlin Goodwin MSN, CNM, RN
Caitlin Goodwin is a Certified Nurse-Midwife who has been a nurse for 12 years, primarily in women’s health. She is passionate about caring for children with developmental disabilities, as her son has Autism Spectrum Disorder. Caitlin loved working as a camp nurse for a summer camp for those with special needs